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Improved DTOC rates will enable LGA to 'stand up' to Simon Stevens

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Improved performance on delayed transfers of care attributable to social care during a spike in emergency hospital admissions in January has put local government in a strong position to challenge NHS England chief executive Simon Stevens over the role of councils in the health system, according to the chair of Local Government Association.

The latest figures show system-wide performance on delayed transfers deteriorated by 1.4% between December 2017 and January 2018, at a time when the number of emergency admissions increased overall by 5,731.

However, analysis by Impower shows while delays attributable to the NHS increased by 4.7% over the period, delays due to social care fell by 2.7%.

Lord Porter (Con) said the latest figures provided a “stark realisation” for the government that social care and the “national unwell service” are “better affected” by councils.

Speaking following a speech by social care minister Caroline Dinenage to the LGA councillors forum on Thursday, Lord Porter referred to the delayed transfer targets imposed by the government on councils in July last year, which included a threat of potentially losing control of funding.

“The money we’ve been spending has delivered considerably more benefit and more bed space than spending money on the health service, so I think we are in the strongest position that I can recall being in,” he said.

Addressing council leaders, Lord Porter added: “If there’s nothing else you do today, go back and thank your teams for all they have done because they have given us as an organisation the ability to start standing up to [Simon Stevens].

“I think [health and social care secretary] Jeremy [Hunt] gets it about working together rather than Simon Stevens’s parochial bit about tanks on lawns.”

Speaking at the LGA conference soon after the targets had been imposed, Mr Stevens provoked anger when he told delegates that “laissez faire had not worked”.

Impower’s analysis reveals 115 of 151 councils have improved their performance on social care attributable delays since February last year, which was the baseline used by the government for targets set last July as part of the better care fund planning guidance.

After the July target was set, the Department of Health and the Department of Communities & Local Government, as they were known at the time, subsequently wrote to councils in December to say delayed transfers performance would be judged on five criteria.

The criteria are: whether councils hit their targets in September 2017; whether performance had improved since the corresponding month in the previous year; whether performance had improved since February last year; and whether the council is in the bottom quartile for delayed transfer rates per 100,000 of the population.

The letter also said areas would be judged on whether performance is below the government’s national target for delayed bed days attributable to social care at a rate of 2.6, which forms part of a target for reducing overall delayed transfer rates across the country, including those attributable to the NHS, to 9.4.

The analysis shows a total of 10 councils failed to meet any of these criteria, compared to 15 in the previous month.

Of the 10, six councils are currently part a health and social care system operating above the government’s national target rate for delayed transfers of 9.6 and therefore considered at the most risk of some form of intervention.

The six councils failing to meet the government criteria and operating in health and social care areas operating above the national target.

Bristol City Council

Leeds City Council

Liverpool City Council

Norfolk CC

Warrington MBC

City of York Council

City of York’s corporate director for health, housing and adult social care Martin Farran said delayed transfer figures fluctuate, with performance deteriorating since October.

He added: “However, we put in additional support services and this has resulted in a significant improvement.

“Equally, the performance when viewed across the last 12 months demonstrates an improvement and positive trend overall.”

A Bristol spokesman said work was being done to improve the council’s offer to providers.

Impower’s lead health director Sarah Atkinson said she was surprised system-wide performance had not deteriorated further due to the unprecedented pressures on hospitals in January.

“Overall if you look at the rates of delayed transfers per emergency admission [councils] have made huge progress on processing those people and that demand out the back door of the hospital,” she said. “It shows us that investing in one part of the system can have a very positive impact on another part of the system.”

Ms Atkinson said the social care performance will bolster local government’s position in discussions on the health and social care system.

She added: “This whole process has given social care a seat at the table in terms of resolving system-wide issues. In a way it has been slightly tokenistic before.

“[Councils] have played a significant role in helping to solve that problem and I think that puts [local government] in a much stronger position moving forward because people recognise the role of social care has to play.”

She said the government should think “more creatively” and in a “more positive way” on how it engages with local government on social care in the future.

During her speech at the Local Government Association, Ms Dinenage said health and social care cannot be considered separate as they are “umbilically linked”.

She said “failings” in social care are driving people into hospital, as well as preventing them from leaving, and added funding is “very much a live debate” within government.

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